It is important to realise that acceptance of your claim does not just depend on having a particular condition.
Acceptance of a claim depends mainly on two factors, as follows:
- You are diagnosed with a condition which is covered under your policy; and
- The severity of your condition is such that it meets the terms in your policy.
Sometimes trauma insurance claims are made which do not qualify for acceptance. This can happen, for example, if the condition is covered but is not sufficiently serious to meet the terms specified in the policy.
Claim Requirements
After AIA has been notified of your intention to make a claim, a case manager will be assigned to take responsibility for your claim, and will phone you in the first instance to discuss your condition. If the nature and extent of your condition might be covered under your policy then the case manager will send a letter to you which details the information required to assess your claim. This information will include the following:
- A completed Critical Conditions or Progressive Care Claim Form PDF.
- An original or certified copy of either your birth certificate or your passport.
- The original policy document, or a completed Lost or Destroyed Policy Document Form PDF.
- A Medical Certificate PDF completed by your doctor or specialist.
Following receipt and assessment of the above information, further medical information may be requested by the case manager, including an assessment by an independent medical specialist.
Following receipt of all required documents, the claim is then assessed. On acceptance of the claim, a Claim Discharge Form is prepared and sent to you. The claim amount is then paid after receipt of the signed Claim Discharge Form, and is direct-credited to the bank account you nominate on the form.
Claims Process
The entire claims process can be illustrated as follows:
